Pregnancy is a time of great change within a woman's body, however in a healthy uncomplicated pregnancy, exercise can continue to be safe and is generally recommended for most women. Pilates can be a very beneficial form of exercise during pregnancy if you are conscious of the precautions to take and are knowledgeable about the effects that exercise may have on you and your developing baby. All pregnant women should have a medical clearance before commencing Pilates.

In most pregnancies, regular moderate intensity physical activity is encouraged, however some important considerations when exercising during pregnancy are detailed below.

HOW CAN PILATES HELP DURING PREGNANCY?

As your baby grows, your posture will change. Most women will have an increase in the curve of their lower back as their abdomen grows and this, along with an increase in the weight of the breasts may cause extra strain on the spine. Alterations in your posture may contribute to certain muscles tightening and shortening and others lengthening and weakening.

Pregnancy hormones cause a 'softening' of your ligaments, potentially leading to reduced joint support. This, along with the extra strain on the pelvic floor and abdominal muscles as your baby grows, generally results in less support of the lower back and pelvis. Commonly the central vertical abdominal muscles stretch and separate at their midline. This is known as a rectus abdominis diastasis. While it is important to maintain abdominal muscle strength during pregnancy, correct exercise technique is essential, as performing conventional sit-up type exercises may actually worsen this separation, potentially putting greater stress on the lower back and pelvic regions. Extra strain on the pelvic floor muscles may mean they don't work quite as well as they should, possibly resulting in impairments in bladder and bowel function such as incontinence and reduced support of the pelvic organs, which may manifest as a pelvic organ prolapse

Pilates can help to maintain the strength of the pelvic floor and abdominal muscles and minimize the adverse effects of the postural changes that result. As these movements are very precise, closely supervised instruction is important, since incorrect activation will not result in the desired outcome, or worse, may aggravate an existing problem or cause an injury. For this reason learning Pilates from a book or DVD is generally not recommended, especially when pregnant, as certain modifications will need to be made to many of the exercises.

IMPORTANT CONSIDERATIONS WHEN EXERCISING DURING PREGNANCY

· Avoid overheating. Your growing baby does not have the same ability to dissipate heat as you do. Consequently, if you become overheated when exercising, your baby can be put at risk. This is particularly true during the first trimester, when the most important growth, cell reproduction and formation are occurring. To avoid overheating:

- Stay well hydrated. Ensure you bring a water bottle and drink plenty of water before, during and after your session even if you do not feel thirsty.

- Don't use sweating as an indicator of how hot you may be getting, as your core temperature may rise disproportionately to the amount of perspiration.

- Avoid exercising in hot, humid conditions.

- Wear light-weight, loose fitting clothes - cotton is best,

- Avoid saunas and steam baths at all times during pregnancy. Your core temperature may be rising without an associated feeling of being hot.

· Avoid high intensity exercise. As your pregnancy progresses, your increased weight will add to the overload effect of exercise and you may need to switch to lighter resistance or easier versions of exercises you currently perform. A good guide is that you should be able to comfortably carry on a conversation throughout the session – referred to as the 'talk test'. Make sure that you always exercise at your own pace and avoid holding your breath.

· When exercising, avoid rapid changes of position and stopping suddenly. Keep the feet moving to help the circulation and prevent leg cramps and faintness.

· With exercise pregnant women sometimes experience low blood sugar levels, resulting in light-headedness or faintness. Eat some form of carbohydrate before and after exercising to help keep blood sugar levels from fluctuating too much

· Limit the amount of exercise you do lying on your back from 16 weeks on. Exercising on your back (as when doing abdominal exercises) could cause a reduction in blood flow to your heart and head, causing you to feel faint and light headed. More importantly, the blood flow to the placenta and baby can decrease. If you do feel at all dizzy or light-headed when lying on your back, turn onto your side and rest.

· Modify your abdominal work. If a rectus abdominis diastasis is present, abdominal muscle exercises which involve lifting the head should cease. Throughout your pregnancy your abdomen should be monitored for any signs of a diastasis, and if present, regular checks should continue to assess the extent of separation.

· Perform pelvic floor muscle exercises. Strengthening these muscles will help to support your trunk and pelvis and also help to prevent impairments in bladder and bowel function such as incontinence and reduced support of the pelvic organs, which may manifest as a pelvic organ prolapse. When performing these exercises you should feel a squeeze and lift movement. If you are unable to feel the correct muscle action, or are experiencing any leakage, seek advice from a physiotherapist with further qualifications in Continence and Women's Health.

· Wear a good supportive maternity bra.

· Stretch gently. Pregnancy hormones cause increased joint laxity, which may make you more susceptible to injury. Be cautious and gentle with your stretching.

Stop exercising and seek medical advice if you experience any of the following:

· American College of Obstetricians and Gynecologists “Guidelines for exercise during pregnancy” 2003

· Royal College of Obstetricians and Gynaecologists (2006) Exercise in Pregnancy (RCOG Statement 4)

PILATES AND YOUR PELVIC FLOOR MUSCLES

The pelvic floor muscles (PFM) act as a dynamic platform at the base of the pelvis, functioning both as a support mechanism for the abdominal organs and as an aid to bladder and bowel function. Well-trained pelvic floor muscles may contribute to orgasmic potential in women and erectile function in men.

PFM action is a 'lift and squeeze' movement: it is the action used to stop midstream urine flow and to stop the passage of wind. It is essential to perform this movement accurately to improve the muscles.

As part of a Pilates initial assessment at LifeCare centres, PFM activity may be assessed using real time ultrasound. During this assessment, the 'lift' component of a PFM contraction can be assessed via visualization of the movement of a full bladder. During Pilates exercises, the PFM are activated in combination with the deep abdominal muscles, while maintaining a relaxed breathing pattern to ensure optimal support for the trunk.

Once you have found the correct PFM action, the next part of the strengthening process is to hold the contraction and repeat it. At first you may only be able to perform short holds, with difficulty maintaining the contraction as you continue to breathe in and out. The aim is to gradually increase the length of hold.

As well as sustained holds, practicing short, sharp, fast contractions will train the muscles to work in a different way. A real time ultrasound assessment will assist in determining how many contractions you should be performing per exercise session.

Women who are unsure as to whether they are performing PFM exercises correctly are advised to consult a Physiotherapist with further qualifications in Continence and Women’s Health for further assessment.

FOR FURTHER INFORMATION contact your local Women's Health and Continence Physiotherapist